NPI | 1285803874 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 111NS0005X Chiropractor Sports Physician (Licence: TX 4340) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 10809) |
Enumeration Date | 2008-02-27 |
Last Update Date | 2008-02-27 |